Provider Demographics
NPI:1124697941
Name:HODGES, MARC (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:HODGES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 E DES MOINES CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2367
Mailing Address - Country:US
Mailing Address - Phone:619-709-6969
Mailing Address - Fax:
Practice Address - Street 1:40 BURTON HILLS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-5902
Practice Address - Country:US
Practice Address - Phone:615-647-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist